In a patient with a hip or knee replacement and a new or worsening pain, ask first whether there has been a fall, however minor. A periprosthetic fracture can follow a low-energy fall and be subtle on a plain film.
Look at the whole length of the implant on imaging, and ask for further views or cross-sectional imaging if the story is convincing and the film is not.
- Ask about a recent fall, even a minor one, in any painful arthroplasty.
- Check the whole implant on radiographs, including the stem tip.
- Order further imaging when the history is convincing and films are unclear.
- Refer early if a fracture is suspected, since implant stability decides management.
Why it matters
A missed fracture around an implant turns a manageable problem into a harder one.
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